Provider Demographics
NPI:1750331732
Name:BANKURU, SATISH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:KUMAR
Last Name:BANKURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 BOULVARD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1338
Mailing Address - Country:US
Mailing Address - Phone:804-504-0068
Mailing Address - Fax:804-504-0080
Practice Address - Street 1:3601 BOULVARD
Practice Address - Street 2:SUITE C
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1338
Practice Address - Country:US
Practice Address - Phone:804-504-0068
Practice Address - Fax:804-504-0080
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236668207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010206391Medicaid
VAMC10242Medicare PIN
VA00W156S02Medicare ID - Type Unspecified
VA010206391Medicaid